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<br />NDV-24-04 <br /> <br />I 21am <br /> <br />F'Dm-ACCO SERVICE OPERATIONS <br /> <br />+18182462841 <br /> <br />T-801 <br /> <br />P.008/005 <br /> <br />F-2ß4 <br /> <br />, POLICY NlJMBI:R: ATC2J-CO.9494A136 <br /> <br />COMMERCIA~ GENERAL LlABI~fTY <br />ISSUE DATE: 10/1/2004 <br /> <br />--" <br /> <br />THIS I:NDORSEMENT CHANGES THE POUCY. PLEASE READ CAREFULLY <br /> <br />ADDITIONAL INSURED - OWNERS, lESSEES OR <br />CONTRACTORS - COMPLETED OPERATIONS <br /> <br />This end IfSfmeml modifies insurançe prov:id9d under the fOllowing: <br />. COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <br />ACCO/_ACCOS~RI65:>1 <br /> <br />SCHEDULE <br /> <br />Name of Person or Organization: <br /> <br />ThE' ( It;< of Santa Ana. lis Officers. Employees. Agents and Representatives are named as Addilional <br />Ins.IJr! d*;. <br /> <br />/ <br /> <br />Looat 011 And Desoription of Completed Operations: <br />CÎt)' Q Sunta Ana. 20 Civic Center Plaza. Santa Ana, CA <br /> <br />'"'-' <br /> <br />Addit onal Premium: <br /> <br />(n no .ntry appears above, information required to complete this endorsement will be shown in the Declarations <br />as ap¡ licable to this endorsement) <br /> <br />Secti >n 11- Who is An Insured is amended to inciude as an insured the person or organi;zation shown <br />in I'm Schedule, but only with respect to liability arising out of "your work" at the location designated <br />and e .scribed in the schedule of this endorsement performed for that insured an included in the <br />'pred lets-completed operations hazard". <br /> <br />SEVE \A 31L1TY OF INTEREST <br />It is 81 reE.'(j that the above policy contaIns a standard cross liability or sevarabillty of intere$t clause. <br /> <br />~jtl'~ . 1 <br />If/!IJ~ <br /> <br />C02( )'/1001 <br /> <br />COpyrlgh~. The Travêl9\'S. Indemnity Company <br /> <br />7C5M4ei¡ 2/3 <br /> <br />0_-.-/0 <br /> <br />